Isigaba 4 I-Renal Cell Carcinoma: Ukwelashwa Nokuqagela

-Delile

• Izinketho zokwelashwa ze-RCC
• Ukuhlinzwa
• I-Immunotherapy
• Izivimbeli zokuhlola
• I-Interleukin-2
• I-Interferon alpha
• Ukwelashwa okuhlosiwe
• mTOR inhibitors
• Ukwelashwa ngemisebe
• Ukwelashwa ngamakhemikhali
• Ukuhlolwa kwemitholampilo
• Isiteji se-renal cell carcinoma
• Umbono

I-Renal cell carcinoma (RCC) uhlobo lomdlavuza oluthinta amaseli ezinso. I-RCC uhlobo oluvame kakhulu lomdlavuza wezinso. Kunezici eziningana zobungozi bokuthuthukisa i-RCC, kufaka phakathi:

• umlando womndeni walesi sifo
• ukubhema
• ukukhuluphala ngokweqile
• umfutho wegazi ophakeme
• isifo sezinso se-polycystic

Lapho kutholakala kuqala, maningi amathuba okuba uthole ukwelashwa okuphumelelayo.

Izinketho zokwelashwa ze-RCC

Yize isigaba se-4 RCC sihlukaniswa njengesigaba esithuthukile somdlavuza, kusekhona izinketho zokwelashwa ezitholakalayo.

Ukuhlinzwa

Kwezinye izimo, lapho isimila esikhulu sisuswa futhi umdlavuza ungasakazeki kakhulu, kungenzeka i-nephrectomy enkulu. Lokhu kuhilela ukukhipha ngokuhlinzwa noma iningi lezinso ezithintekile.

Ukususwa kokuhlinzwa kwezinye izicubu kungadingeka kubantu abanomdlavuza we-metastatic. Ithimba lochwepheshe lizonquma ukuthi ngabe izicubu zemetastasized zingasuswa ngaphandle kwengozi enkulu.

Uma ukuhlinzwa kungenakwenzeka, ukuhlanganiswa kwe-tumor kungasetshenziswa. Le nqubo inqamula ukunikezwa kwegazi ku-tumor, okusiza ukunciphisa izimpawu.

Lapho ukuhlinzwa sekwenziwe ukukhipha izicubu zendawo, abantu abaningi bangadinga ukwelashwa okuhlelekile. Lolu hlobo lokwelashwa lwelapha umdlavuza emzimbeni wonke. Kungasiza ekunciphiseni ukubuya komdlavuza.

Ukwelashwa okuhleliwe kwesigaba 4 i-RCC kufaka phakathi i-immunotherapy, ukwelashwa okuhlosiwe, imisebe kanye ne-chemotherapy.

I-Immunotherapy

I-Immunotherapy yindlela yokwelashwa ehlose ukukhuthaza amasosha omzimba ukuthi ahlasele amangqamuzana omdlavuza. Akuwona wonke umuntu one-RCC ophendula kahle ku-immunotherapy, futhi imiphumela emibi ingaba mibi kakhulu.

I-Immunotherapy, noma i-biologic therapy, ukwelashwa okusiza amasosha akho omzimba ahlasele umdlavuza. Kuvame ukwethulwa lapho i-RCC ingenakususwa ngokuhlinzwa.

I-Immunotherapy isebenzisa izinhlobo ezimbalwa zemithi:

Izivimbeli zokuhlola

Amasosha omzimba wakho asebenzisa uhlelo "lwezindawo zokuhlola" ukwehlukanisa phakathi kwamaseli aphilile nawomdlavuza. Ama-Checkpoint inhibitors ahlose ukusiza amasosha akho omzimba ukuthi athole amangqamuzana omdlavuza afihlekile kumasosha akho omzimba.

I-Nivolumab (i-Opdivo) iyisithiyo sokuhlola esilawulwa nge-IV esibe ekwelashweni kwe-RCC eminyakeni yamuva.

Imiphumela emibi ifaka phakathi:

• ukuqubuka
• ukukhathala
• isifo sohudo
• isicanucanu
• ikhanda
• ukuqubuka kwesikhumba
• ubuhlungu obuhlangene
• ubuhlungu besisu
• inkinga yokuphefumula

I-Interleukin-2

I-Interleukin-2 (IL-2, Proleukin) yikhophi lokufakelwa lamaprotheni abizwa ngama-cytokines ahlose ukusebenzisa amasosha omzimba wakho ukuba ahlasele amangqamuzana e-tumor.

Kuboniswa ukuthi inamandla oku. Kungaba nemiphumela emibi kakhulu ngakho-ke kusetshenziswa kuphela kubantu abaphilile abangabekezelela imiphumela emibi.

Enye yokusebenza kahle kwabesilisa abamhlophe kakhulu abanefomu elinolaka le-RCC babone inani eliphakeme lokusinda ngokusebenzisa i-interleukin-2 enomthamo omkhulu.

Imiphumela emibi ifaka phakathi:

• ukukhathala
• ukopha
• Ukugodola
• imfiva
• umfutho wegazi ophansi
• uketshezi emaphashini
• ukulimala kwezinso

I-Interferon alpha

Ama-interferon ane-antiviral, antiproliferative (evimbela ukukhula komdlavuza weseli), kanye ne-immunomodulatory (kuthinta amasosha omzimba) izakhiwo. I-Interferon alpha ihlose ukumisa amangqamuzana ezimila ekuhlukaneni nasekukhuleni.

I-Interferon kwesinye isikhathi inikezwa nezinye izidakamizwa, njenge-bevacizumab (Avastin).

Imiphumela emibi ye-interferon ihlanganisa:

• isicanucanu
• izimpawu ezinjengomkhuhlane
• ukukhathala

Ama-interferon athathelwe indawo kakhulu ukwelashwa okubhekiswe kumenzeli oyedwa. Ukwelashwa kwe-single-agent interferon ngokuvamile akusasetshenziswa.

Ukwelashwa okuhlosiwe

Ukwelashwa okubhekiswe ku-RCC kusho ukusebenzisa izidakamizwa eziqonde ngqo kumaseli womdlavuza. Izidakamizwa ezihlosiwe ziyathandeka ngoba azilimazi noma zibulale amaseli anempilo emzimbeni.

Kunemithi eminingi ehlosiwe yesigaba 4 RCC esebenza ukuvimbela ukukhula kwamaseli. Bakhomba iprotheni ebizwa nge-vascular endothelial growth factor (VEGF) evuselela ukukhula kwamangqamuzana omdlavuza.

Ukwakhiwa kwale mithi ehlosiwe kusize ukunweba izimpilo zeziguli ezithile zesigaba sesine. Le ndlela yokwelashwa ikhombise ukuthi ithembisa ngokwanele ukuthi abacwaningi baqhubeke nokwakha imishanguzo emisha ehlosiwe.

Umuthi i-bevacizumab (Avastin) uvimba i-VEGF futhi ulawulwa ngomthambo.

Imiphumela emibi ifaka phakathi:

• isifo sohudo
• ukuncipha komzimba
• ukuquleka
• ukulahlekelwa isifiso sokudla
• isilungulela
• izilonda zomlomo

I-tyrosine kinase inhibitor (TKI) imisa ukukhula okusha kwesitsha segazi kwizicubu futhi iza ngefomu lephilisi. Izibonelo zalolu hlobo lomuthi zifaka:

• I-sorafenib (Nexavar)
• i-cabozantinib (Cabometyx)
• i-pazopanib (Votrient)
• i-sunitinib (Sutent)

Imiphumela emibi yama-TKI ifaka phakathi:

• umfutho wegazi ophakeme
• isicanucanu
• isifo sohudo
• ubuhlungu ezandleni nasezinyaweni zakho

mTOR inhibitors

Ukuqondiswa kwemishini ye-rapamycin (mTOR) inhibitors kuhlose iprotheni ye-mTOR, ekhuthaza ukukhula komdlavuza wamaseli wezinso.

Lokhu kufaka phakathi:

• i-temsirolimus (Torisel), ilawulwa nge-IV
• everolimus (Afinitor), ethathwe ngomlomo ifomu lephilisi

Imiphumela emibi ifaka phakathi:

• ukuqubuka
• ubuthakathaka
• ukulahlekelwa isifiso sokudla
• izilonda zomlomo
• uketshezi oketshezi ebusweni noma emilenzeni
• ushukela ophakeme wegazi ne-cholesterol

Ukwelashwa ngemisebe

Imisebe isebenzisa imisebe ye-X-ray enamandla amakhulu ukubulala amangqamuzana omdlavuza. Imisebe nayo ingasetshenziswa ngemuva kokuhlinzwa ukubulala noma yimaphi amangqamuzana omdlavuza asele ngemuva kokwelashwa.

Ku-RCC ethuthukile, kuvame ukusetshenziselwa ukukhulula izimpawu ezinjengezinhlungu noma ukuvuvukala. Lolu hlobo lokwelashwa lubizwa ngokuthi ukunakekelwa okunciphisayo.

Imiphumela emibi yemisebe ifaka phakathi:

• ukucasuka kwesisu
• ukubomvu kwesikhumba
• ukukhathala
• isifo sohudo

Ukwelashwa ngamakhemikhali

I-Chemotherapy iyindlela yokwelashwa yendabuko yezinhlobo eziningana zomdlavuza. Kubandakanya ukusebenzisa umuthi noma inhlanganisela yezidakamizwa ukubulala amangqamuzana omdlavuza.

Imithi ye-Chemotherapy ayihlosiwe, noma kunjalo, ngakho-ke ibulala namaseli anempilo futhi ikhiqize imiphumela emibi eminingi.

I-Chemotherapy imvamisa ayisebenzi kahle kubantu abane-RCC. Kodwa-ke, udokotela wakho angayincoma uma ngabe i-immunotherapy kanye nokwelashwa okuqondisiwe kungasebenzi.

Le ndlela yokwelashwa ithathwa ngemithambo yegazi noma ngefomu lephilisi. Inikezwa ngemijikelezo enezikhathi zokuphumula ezingena ngezikhathi ezithile. Ngokuvamile udinga ukuthola i-chemotherapy njalo ngenyanga noma njalo ezinyangeni ezimbalwa.

Imiphumela emibi ifaka phakathi:

• ukukhathala
• izilonda zomlomo
• isicanucanu nokuhlanza
• uhudo noma ukuqunjelwa
• ukulahleka kwezinwele
• ukulahlekelwa isifiso sokudla
• ingozi eyengeziwe yokutheleleka

Ukuhlolwa kwemitholampilo

Enye inketho yabantu abasesiteji 4 RCC ukubamba iqhaza ezivivinyweni zokwelashwa. Ukuhlolwa kwemitholampilo yizilingo zocwaningo zokuhlola imishanguzo emisha kanye nokwelashwa.

Ungaxoxa ngokuhlolwa kwamanje kwemitholampilo - kanye nezingozi nezinzuzo zayo - nodokotela wakho noma umhlinzeki wezokunakekelwa kwempilo.

Isiteji se-renal cell carcinoma

Odokotela abathola futhi baphathe i-RCC nezinye izinhlobo zomdlavuza basebenzisa uhlelo lokubeka iziteji. Umuntu ngamunye one-RCC unikezwa inombolo yenombolo esukela ku-1 kuye ku-4. ISigaba 1 yisigaba sokuqala sesifo kanti isigaba 4 yisona sakamuva futhi esithuthuke kakhulu.

Isiteji se-RCC sisuselwa ku:

• usayizi wesimila sokuqala ezinso
• ukusabalala kwamangqamuzana anomdlavuza kusuka ku-tumor yokuqala kuya ezicutshini eziseduze
• izinga le-metastasis
• ukusabalala komdlavuza kwezinye izitho zomzimba

Isigaba 4 RCC singafaka inhlanganisela ehlukile yezinqubo zokubeka iziteji:

• Lapho isimila sokuqala sikhulu futhi sesisabalele kuzo zonke izinso nasezicutshini eziseduze. Kulesi simo, amangqamuzana omdlavuza kungenzeka ukuthi asakazekele kwezinye izitho emzimbeni.
• Lapho umdlavuza usuthole isisu futhi utholakala ezithweni ezikude. Kulokhu, isimila sokuqala singaba nosayizi, futhi kungahle kube noma awukho umdlavuza ezicutshini ezizungeze izinso ngokushesha.

Umbono

Izinga lokusinda elihlobene iminyaka emihlanu labantu abanesigaba 4 RCC lingamaphesenti ayi-12. Kodwa-ke, izimo ezahlukahlukene zingaholela emazingeni aphezulu okusinda.

Abantu abakwazi ukuhlinzwa ukuze kususwe izicubu ze-metastatic banamazinga angcono okusinda, futhi abaningi abaphathwa ngemithi ekhonjiwe baphila isikhathi eside kunalabo abangenayo.